潛水過程造成的生理變化與潛水員自身的健康狀態可能影響水肺潛水（以下簡稱潛水）的安全。本文透過文獻回顧，先彙整潛水所帶來的生理變化與可能的健康風險，再討論高血壓、糖尿病與氣喘等三種慢性疾病及其用藥對潛水員安全的影響，以及相對安全的用藥選擇。欲從事潛水的高血壓患者，除了留意血壓控制外，可優先選擇較不影響潛水安全的降血壓藥物。 Angiotensin converting enzyme inhibitors (ACEIs) 與angiotensin receptor blockers (ARBs) 為較理想的選擇，不過服用ACEIs應留意乾咳可能影響潛水員在水下的呼吸。使用calcium channel blockers 需留意姿態性低血壓的發生，而服用diuretics 及β-blockers 則較不建議從事潛水。患有糖尿病的潛水員，血糖控制應符合從事潛水的標準，並留意降血糖藥物可能造成低血糖事件發生。氣喘是肺氣壓傷、動脈氣體栓塞等潛水疾病的危險因子，因此控制不穩定的氣喘應視為潛水的禁忌症。氣喘患者從事潛水前應進行肺量計檢查，符合條件的潛水員也建議使用尖峰呼氣流速計追蹤峰值呼氣流量 (peak expiratory flow)，以確保當天身體狀況適合潛水。使用吸入型類固醇、吸入型長效乙二型交感神經刺激劑或白三烯受體拮抗劑治療並控制良好的氣喘患者，並非潛水的禁忌症。
Physiological changes during diving and the health status of divers can impact the safety of scuba diving. This article provides a literature review summarizing the physiological changes associated with diving and potential health risks. It also discusses the impact of hypertension, diabetes mellitus, and asthma, including their pharmacotherapy, on diving safety. Divers with hypertension should aim to maintain their blood pressure within the recommended range. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are preferred choices, but divers taking ACEIs should be aware of the possibility of dry cough affecting their breathing underwater. Divers using calcium channel blockers should be cautious of orthostatic hypotension. Diuretics and beta-blockers are not recommended for divers. Divers with diabetes should maintain stable blood glucose level and be mindful of the potential occurrence of hypoglycemia associated with hypoglycemic agents. Unstable asthma is considered a contraindication for diving due to the risk of pulmonary barotrauma and arterial gas embolism. Asthmatic divers should undergo spirometry measurements to assess the suitability for diving, and the use of peak expiratory flow measurements is recommended to ensure optimal conditions for diving. Divers with well-controlled asthma using inhaled corticosteroids, long-acting beta-2-agonists, or leukotriene receptor antagonists are not contraindicated for diving.
Submitted for publication: 2022.11.28; Accepted for publication: 2023.3.9
